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The pediatric exam with immunization is a stressful event for young children. Its characteristics are close to the classic “strange situation”: a perceived threat that activates the attachment system, a stranger, and an unfamiliar environment. It can be used as a natural situation to assess the quality of the mother-child attachment, with two main goals: (i) to manage the stress of the toddler during the pediatric exam and (ii) to screen for relationship disturbances. We have developed a specific coding instrument, the Pediatric Attachment Style Indicator (PASI), which is used to classify infant and toddler behavior in the pediatric exam as secure, avoidant, or ambivalent. This paper presents the PASI instrument and its validation. Pediatric exams ( N = 41 mother and toddler dyads) were videotaped during a regular booster session for DTaP immunization in Geneva, Switzerland. Results of the PASI coding were compared with the results of other instruments of direct observation of emotional behavior of the toddler and of the mother, with the information given by the mother to the toddler before the exam, and with the assessment of temperament of the toddler by the pediatrician. Results show good construct validity for the instrument.